Micro Nutrition

nutrients needed in smaller amounts

primarily obtained in diet

do not contain calorites

micronurtrients

nine water soluble vitamins

vitamin b and c (b’s and c’s you pee)

putting back nutrients that were lost during processing

enriched

adding additional micronutrients that were not present prior to processing

fortification

B1 aka

thiamine

B2 aka

riboflavin

B3 aka

niacin

b5 aka

pantothenic acid

b6 aka

pyridoxine

b7 aka

biotin

b9 aka

folate

b12 aka

cobalamin

average daily intake sufficient to meet nutrient requirements of nearly all healthy, used for planning

RDA, recommended daily allowance

intake at this level is assumed to ensure nutritional adequacy, established when eveidence isnt enough for RDA

adequate intake, AI

average daily level of intake estimated to meet requirements of 50% of healthy individuals

estimated average requirement (EAR)

max daily intake unlikely to cause adverse health affects

tolerable upper intake level (UL)

cofactor for various enzymes crucial for glucose breakdown and energy metabolism

no upper limit due to lack or research showing adverse effects

thiamine, B1

nervous system affected, polyneuropathy and muscle wasting

may damage mammillary bodies and thalamus’s medial dorsal nucleus

dry beri beri

sequelae of dry beri beri

confusion, opthalmologies, speech difficulties, ataxia

wernicke encephalopathy

dry beri beri plus memory loss and personality changes

wernicke korsakoff syndrome

CV system and high output HF with dyspnea and exertion and edema, vitamin b1 deficiency

wet beri beri

meat, yogurts, fish beans lentils and whole grains

fortified in breadsd cereal and baby formula

thiamine

in foods and supplements

bacteria in large intestine can produce a small amount

key comp of coenzymes involved in growth of cells, energy production, and breakdowns of fats, steroids, and medication

riboflavin, b2

coenzyme assoc with b2

FMN and FAD

angular stomatitis, glossitis, cheilosis, cracked lips, hair loss, rash, anemia, itchy red eyes, cataracts in severe

riboflavin deficiency

dairy milk

yogurt

cheese

eggs

lean beef and pork

organ meats

chicken breast

salmon

fortified cereals and bread

almonds

spinach

riboflavin sources

nicotinic acid and nicotinamide most common form in food

body can convert tryptophan to nicotinamide

niacin, b3

malnutrition, excess alcohol, bariatrtic surg, carcinoid syndrome, hartnup disease

causes of niacin deficiency

tryptophan oxidized to serotonin and not metabolized to niacin

carcinoid syndrome leading to niacin deficiency

genetic disorder interefered with absorption of tryptophan and increases loss in urine

hartnup diease leading to niacin deficiency

4 d’s: diarrhea, dementia, photosensitive dermatitis, death

pellagra, niacin deficiency

red meat, poultry, fish, brown rice, fortified cereals and bread, nuts/seeds, legumes, banana

niacin sources

found in all living cells, used to make CoA

gut can produce some but not enough to meet needs

pantothenic acid, b5

seen in severe malnutrition, but very rare

pantothenic acid deficiency

in coenzyme form

wide variety of function in body involved in lots of enzyme reactions (protein metabolism)

absorbed in jejunum

can measure in plasma

b6, pyridoximine

deficiency not common, seen when there are other b vitamin deficiencies

b6 deficiency

kidney disease, chrons, ulcerative colitis, etoh abus, antiepileptic drugs (valproate, carbamazeapine, phenytoin)

risk factors for b6 deficiency

recommended as first line treatment of morning sickness

vitamin b6

second line is to add doxylamine

dark leafy greens primarily

source of b6

cofactor for 5 carboxylases that start crit steps in metabolism of FA, glucose, and amino acids

b7, biotin

most are bound to proteins

biotin

deficiency never reported in person with normal mixed diet

biotin b7 deficiency

rare autosomal recessive disorder usually found at birth bc part of newborn screen

biotinase deficiency

found in food or supplementation, helps form dna and rna, involved in protein metabolism, and needed to make rbs

folate (food) folic acid (supplementation)

key role in breaking down homocysteine (Which can be harmful in high levels)

folate

RDA is defined as dietary folate equivalents,

need how many mcg in pregnancy

600 mcg DFE in preg (500 in lactation)

megaloblastic anemia (weakness fatigue increased MCV SOB and palpitations)

shallow ulcerations on tongue, change in hair skin nails pigmentation elevated homocysteine levels

folate deficiecy

plays critical role in metabolism of folate, methalation cycle which helps with dna synthesis repair and gene expression

MTHRFR mutation

homozygous form reduced MTHRFR enzyme activity

heterozygous milder, increased CVD, neural tube defects, and preg complcations

c677T

neural tube defects, failure of neural tube to close

spina bifida and anencephaly,

folate deficiency

timing of folate supplementation

must be taken within first few weeks after conception

needed to form rbc, dna and myelin

binds to protein in foods we eat

b12, cobalamin

HCL and enzymes break B12 down and it then

binds with intrinsic factors so it can be absorbed in terminal ileum

stored in liver more readily than other b vitamins

b12

high homocysteine level assoc with

increased risk CVD

involved in breakdown of homocysteine

b12

vegan/vegetarian, pernicious anemia, decreased stomach acid (PPI meds), bariatric surgery, resected terminal ileum, crohn’s disease, celiac disease

risk factors for b12 deficiency

megaloblastic anemia, pernicious anemia, fatigue weakness, numbness (bilat usually) in hands/feet/legs,memory loss, depression and seizures

b12 deficiency symptoms

primarily found in animal products, if vegain add nutrition or brewers yeast, must be fortified

b12 sources

not well stored and humans can’t synthsize

ascorbic acid, vitamin c

needed to make collagen and play vital role in controlling infections adn healing wounds

vitamin c

stabilize vitamin ee and folic acid

enhances iron absorption

helps neutralize free radicals

vitamin c

smoking depletes levels

vitamin c, add 35mg additional

loss of collagen that weakens CT, seen as soon as 1-3 months with reduced intake

easy bruising and bleeding

swelling and bleeding of gums

hair loss and delayed wound healing

iron deficiecny anemia due to decreased absorption of non heme iron

scurvy

fat soluble vitamins

ADEK

eye health, stimulate WBC production, bone remodeling, reg cell growth and decision needed for reproduction

vitamin A

leading cause of preventable blindness in children worldwide

vitamin a deficiency

two forms of vit a

ppreformed vit a (retinol)

provitamin a (carotene)

xerophthalmia, night blindness first, may progress to keratinization

vit a deficiency

cystic fibrosis, IBD, intestinal surgery

vitamin a def risk factors

calciferol

vitamin d

ergocalciferol aka

vit d2

cholescalciferol

d3, animal and humans, skin is primary source

sun has three letters, vitamin d3

few foods naturally contain but some are fortified

vit d

absorbed in small intestine

needed for bone mineralization, growth adn remodeling

role in reducing inflammation and modulate cell growth etc

vit d

skeletal deformities caused by failure of bones to harden

in kids and infants

rickets

vit d deficiency

existing bone is incompletely mineralized during remodeling causing weak bones

often precursor to osteoporosis

osteomalacia

few sources are rich

fatty fish

certian mushrooms

SUNSHINE

egg yolk

vit d sources

alpha tocopherol only form in human body

antioxidant

helps with immune function

no UL but some risk for excessive bleeding

vit e

retinopathy, peripheral neuropathy, ataxia

decreased immune fxn

vit e deficiecny

plant based oils

source for vit e

found in 2 forms

helps make proteins for clotting and building bone

vit k

two forms of vit k

phylloquinone: green leafy veggies

menaquinone: animal sources and fermented foods, some bacteria in humans produce

seen in malabsorptive disorders

cf, uc, celiac, bar surg, short bowel syndrome

vit k def

inorganic elements present in soil and water absorbed by plants and consumed by animals

greater amounts needed with (name 4)

minerals

calcium

potassium

iron

zinc

what needs to be supplemented in post menopausal women in high osteoporosis risk?

Calcium and vit d

what mineral is gentle on stomach and crosses BBB

ideal for anxiety, insomnia depression, muscle relaxation

magnesium glycinate

used in burns and wound management

helps with healing and growth of cells

zinc

most common mineral deficiency after gastric bypass

iron calcium zinc and copperi

if potassium is low in patient, need to check

magnesium